Healthcare stakeholders are watching in horror as the fate of a number of critical healthcare programs has gotten bound up in Congress' intractable political battle over immigration.
The short-term continuing budget resolution approved by lawmakers Jan. 22 to keep the federal government open through Feb. 8 provided a big jolt of relief by extending funding for the Children's Health Insurance Program for six years, ensuring coverage for nearly 9 million kids.
Medical-device makers, insurers and employers were pleased by provisions delaying enforcement of three Affordable Care Act taxes affecting them, which the Congressional Budget Office said would cost the Treasury $31 billion.
But the continuing resolution deal left federally qualified community health centers, hospitals serving the poor, rural hospitals and substance abuse treatment centers hanging, as President Donald Trump and Republicans and Democrats in Congress seemingly remain far apart on immigration issues.
Hospitals receiving extra Medicaid payments for serving a disproportionate share of low-income and uninsured patients didn't get a hoped-for delay in cuts to those payments. They would see a $2 billion hit in the current fiscal year and $3 billion in cuts in fiscal 2019, according to the American Hospital Association. States decide how to portion out the DSH allotments to hospitals, so the effect on individual hospitals will vary.
In addition, measures to establish a reinsurance program to stabilize the individual insurance market have been stymied.
"We'll start seeing rural hospitals make decisions to close if the Medicare payment adjustment for low-volume hospitals isn't extended," said Diane Calmus, government affairs manager at the National Rural Health Association.
Democrats are demanding legalized status for hundreds of thousands of so-called Dreamers—those who were brought illegally into the U.S. as children by their parents—as the price for supporting an appropriations bill to fund the government for the rest of this fiscal year. Trump has laid out a proposal to legalize 1.8 million Dreamers that includes border security measures and immigration restrictions that many Democrats and some Republicans consider unacceptable.
There is a possibility that the immigration issue could be decoupled from the broader spending bill to fund healthcare programs and a new reinsurance program. "I think it will be separated out," said Christopher Condeluci, a Republican healthcare lobbyist and former GOP Senate staffer.
But any resolution could be blocked by the lack of trust between Democrats and Republicans on immigration. When the current short-term spending resolution ends Feb. 8, "We could have another crisis on our hands," Sen. Chris Murphy (D-Conn.) said.